JobCover6 checklist

This checklist is designed to help a person determine if a proposal meets all the requirements outlined in the JobCover6 program guidance material. A JobCover6 program cannot proceed unless all the requirements are met.

Name of person completing the checklist:

Date (DD/MM/YYYY):

EligibilityWorker:☐ has capacity for work and is looking for new employment☐ at time of program commencement, is receiving or entitled to receive weekly

payments or just prior to the COVID-19 pandemic was engaged in suitable work with their pre-injury employer

☐ has not accepted a commutation or work injury damages settlementEmployer:☐ is not the worker’s pre-injury employer☐ has offered employment for an agreed period☐ holds a current workers compensation policy with an insurer or a self-insurer’s

licence ☐ is not grouped with the pre-injury employer for workers compensation insurance or

insured under the same group self-insurer licence as the pre-injury employer ☐ is not in receipt of any other wage subsidy for the worker ☐ demonstrates adherence to their jurisdiction’s workers compensation and workplace

health and safety legislation

EmploymentEmployment is:

(Tick relevant box)☐ full or part-time work ☐ a casual, labour hire or contract arrangement where work is ongoing and there is a

formal agreement with the employer

☐ temporary and there is a fixed-term agreement ☐ seasonal work

Note: Employment should not be related to the establishment of a small business or other self-employment arrangement.

Conflict of interestPotential conflict of interest has been identified ☐ Yes ☐ No

If yes: ☐ Issues discussed with the insurer, and strategies to address the conflict of interest

have been outlined on the agreement form and sent to SIRA for decision.

Additional supportsConsideration has been given to the need for:☐ a workplace assessment☐ workplace modifications and/or equipment☐ return to work assistance payments:☐ new employment assistance☐ new education and training assistance

☐ transition to work☐ training

Confirming agreement☐ the agreement form has been signed by worker, employer, insurer and workplace

rehabilitation provider (if involved)☐ all parties understand the benefits negotiated, as well as their roles and

responsibilities in using the program☐ the employer knows they should call the worker’s pre-injury insurer and speak to

the program contact person if they have any difficulties☐ all parties have a copy of the signed agreement form